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      Educational interventions in health services and oral health: systematic review.

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          Abstract

          OBJECTIVE To analyze the effectiveness of educational interventions performed in health services in the improvement of clinical behaviors and outcomes in oral health. METHODS We have carried out a systematic review of the literature searching the PubMed, Lilacs, and SciELO databases. We have included studies that have investigated interventions performed by health professionals working in health services and who have used educational actions as main approach to improve behavioral and clinical outcomes in oral health. RESULTS The search amounted to 832 articles and 14 of them met all the inclusion criteria. Five studies have only exclusively evaluated the effectiveness of interventions on caries reduction, three have exceptionally evaluated oral health behaviors, and the other articles have evaluated the effectiveness of interventions for both clinical outcomes (dental caries and periodontal conditions) and behaviors in oral health. Most of the studies (n = 9) were based on randomized controlled trials; the other ones have evaluated before and after the intervention. Five studies have reported a significant reduction of dental caries, and five of the six studies evaluating behavioral outcomes have found some positive change. CONCLUSIONS Most studies evaluating behavioral and periodontal outcomes have shown significant improvements in favor of interventions. All studies evaluating caries have shown a reduction in new lesions or cases of the disease in the groups receiving the interventions, although only five of the eleven articles have found a statistically significant difference. Educational interventions carried out by health professionals in the context of their practice have the potential to promote oral health in the population.

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          Most cited references57

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          Toward a theory of motivational interviewing.

          The widely disseminated clinical method of motivational interviewing (MI) arose through a convergence of science and practice. Beyond a large base of clinical trials, advances have been made toward "looking under the hood" of MI to understand the underlying mechanisms by which it affects behavior change. Such specification of outcome-relevant aspects of practice is vital to theory development and can inform both treatment delivery and clinical training. An emergent theory of MI is proposed that emphasizes two specific active components: a relational component focused on empathy and the interpersonal spirit of MI, and a technical component involving the differential evocation and reinforcement of client change talk. A resulting causal chain model links therapist training, therapist and client responses during treatment sessions, and posttreatment outcomes.
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            Motivational interviewing in medical care settings: a systematic review and meta-analysis of randomized controlled trials.

            Motivational Interviewing (MI) is a method for encouraging people to make behavioral changes to improve health outcomes. We used systematic review and meta-analysis to investigate MI's efficacy in medical care settings. Database searches located randomized clinical trials that compared MI to comparison conditions and isolated the unique effect of MI within medical care settings. Forty-eight studies (9618 participants) were included. The overall effect showed a statistically significant, modest advantage for MI: Odd ratio=1.55 (CI: 1.40-1.71), z=8.67, p<.001. MI showed particular promise in areas such as HIV viral load, dental outcomes, death rate, body weight, alcohol and tobacco use, sedentary behavior, self-monitoring, confidence in change, and approach to treatment. MI was not particularly effective with eating disorder or self-care behaviors or some medical outcomes such as heart rate. MI was robust across moderators such as delivery location and patient characteristics, and appears efficacious when delivered in brief consultations. The emerging evidence for MI in medical care settings suggests it provides a moderate advantage over comparison interventions and could be used for a wide range of behavioral issues in health care. Copyright © 2013. Published by Elsevier Ireland Ltd.
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              From victim blaming to upstream action: tackling the social determinants of oral health inequalities.

              The persistent and universal nature of oral health inequalities presents a significant challenge to oral health policy makers. Inequalities in oral health mirror those in general health. The universal social gradient in both general and oral health highlights the underlying influence of psychosocial, economic, environmental and political determinants. The dominant preventive approach in dentistry, i.e. narrowly focusing on changing the behaviours of high-risk individuals, has failed to effectively reduce oral health inequalities, and may indeed have increased the oral health equity gap. A conceptual shift is needed away from this biomedical/behavioural 'downstream' approach, to one addressing the 'upstream' underlying social determinants of population oral health. Failure to change our preventive approach is a dereliction of ethical and scientific integrity. A range of complementary public health actions may be implemented at local, national and international levels to promote sustainable oral health improvements and reduce inequalities. The aim of this article is to stimulate discussion and debate on the future development of oral health improvement strategies.
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                Author and article information

                Journal
                Rev Saude Publica
                Revista de saude publica
                Universidade de Sao Paulo, Agencia USP de Gestao da Informacao Academica (AGUIA)
                1518-8787
                0034-8910
                2018
                : 52
                Affiliations
                [1 ] Programa de Pós-Graduação em Odontologia, Faculdade de Odontologia, Universidade Federal de Pelotas, Pelotas, RS, Brasil.
                Article
                S0034-89102018000100505
                10.11606/s1518-8787.2018052000109
                5953546
                29791531
                80c1c85b-c0a8-4971-a4c9-66570cd04107
                History

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